Early <i>versus</i> delayed treatment of extension type-3 supracondylar fractures of the humerus in children

Sibiński, Marcin; Sharma, Himanshu; Bennet, G.C.

doi:10.1302/0301-620x.88b3.17181

Cited by 85 publications

(59 citation statements)

References 6 publications

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“…Whether a third pin should be added to be more stable is controversial [19,46], but it may lead simultaneously to the increased risk of nerve injury [51,58]. Different results have been affected by the time from injury to surgery [11,21,22,33,45,47]. In our metaanalysis, the time from injury to surgery of the included trials was inconsistent.…”

Section: Discussionmentioning

confidence: 98%

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Zhao

Wang

Zhang

2013

Clinical Orthopaedics &Amp; Related Research

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Background Closed reduction and percutaneous pin fixation is considered standard management for displaced supracondylar fractures of the humerus in children. However, controversy exists regarding whether to use an isolated lateral entry or a crossed medial and lateral pinning technique. Questions/purposes We performed a meta-analysis of randomized controlled trials (RCTs) to compare (1) the risk of iatrogenic ulnar nerve injury caused by pin fixation, (2) the quality of fracture reduction in terms of the radiographic outcomes, and (3) function in terms of criteria of Flynn et al. and elbow ROM, and other surgical complications caused by pin fixation.Methods We searched PubMed, Embase, the Cochrane Library, and other unpublished studies without language restriction. Seven RCTs involving 521 patients were included. Two authors independently assessed the methodologic quality of the included studies with use of the Detsky score. The median Detsky quality score of the included trials was 15.7 points. Dichotomous variables were presented as risk ratios (RRs) or risk difference with 95% confidence intervals (CIs) and continuous data were measured as mean differences with 95% CI. Statistical heterogeneity between studies was formally tested with standard chi-square test and I 2 statistic. For the primary objective, a funnel plot of the primary end point and Egger's test were performed to detect publication bias. Results The pooled RR suggested that iatrogenic ulnar nerve injury was higher with the crossed pinning technique than with the lateral entry technique (RR, 0.30; 95% CI,. No publication bias was further detected. There were no statistical differences in radiographic outcomes, function, and other surgical complications. No significant heterogeneity was found in these pooled results. Conclusions We conclude that the crossed pinning fixation is more at risk for iatrogenic ulnar nerve injury than the lateral pinning technique. Therefore, we recommend the lateral pinning technique for supracondylar fractures of the humerus in children.

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Section: Discussionmentioning

confidence: 98%

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Zhao

Wang

Zhang

2013

Clinical Orthopaedics &Amp; Related Research

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“…In contrast, there are studies which support the case for early treatment, demonstrating that reduction becomes more difficult for patients with delayed treatment, and the occurrence of compartment syndrome in patients whose treatment is delayed [9][10][11]. As noted, there is still some debate as to whether these fractures should be treated as urgent cases with early intervention, or if patients with delayed treatment also experience satisfactory outcomes [1][2][3][4][5][12][13][14][15]. The goal of this study was to evaluate the treatments and outcomes of patients with Gartland type III supracondylar humerus fractures in order to determine if postponing treatment leads to a higher rate of open surgical treatment or complications.…”

Section: Introductionmentioning

confidence: 99%

An evaluation of supracondylar humerus fractures: Is there a correlation between postponing treatment and the need for open surgical intervention?

Kronner

Legakis

Kovacevic

et al. 2013

Journal of Children's Orthopaedics

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Purpose The goal of this study was to evaluate the treatment and recovery of patients treated for Gartland type III supracondylar humerus fractures in order to determine if postponing treatment leads to a higher rate of open surgical treatment or complications. Methods A retrospective study was conducted examining the medical records of children with Gartland type III supracondylar humerus fractures at our institution for a two-year period. The patients included in the study were treated with closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF). Results After exclusions, 134 patients were included in the study, with an average age of 5.6 years. The patients were grouped according to whether their treatment was postponed (39.6 %) or immediate (60.4 %). The majority of all patients were treated using CRPP: 46 (86.8 %) of the postponed patients and 75 (92.6 %) of the immediate patients. Very few postsurgical complications occurred in the patients; there was only one (1.6 %) case of iatrogenic nerve injury in a postponed patient as well as four (3.8 %) cases of loss of carrying angle: one (2.3 %) in postponed patients and three (4.8 %) in immediate patients. Conclusions Postponing treatment of type III supracondylar humerus fractures in children did not lead to an increase in open surgical treatment; nor did it lead to an increase in complications.

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“…There is still no consensus on which supracondylar humerus fractures can be treated in a delayed fashion, and delayed treatment may increase the need for an open reduction [6,7]. The ''pulseless'' supracondylar fracture remains an emergency [8,9].…”

Section: Introductionmentioning

confidence: 99%

Pediatric supracondylar humerus fractures: Treatment by type of orthopedic surgeon

Farley

Patel

Craig

et al. 2008

Journal of Children's Orthopaedics

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Purpose Outcomes in children with supracondylar humerus fractures were stratified by type of treating orthopedic surgeon: pediatric orthopedic surgeon and nonpediatric orthopedic surgeon. Methods The outcome factors in 444 children examined included: open reduction rate, complications, postoperative nerve injury, repinning rate, need for physical therapy, and residual nerve palsy at final follow-up. Results For the severe fractures, significantly more fractures were treated by open reduction in the pediatric orthopedic surgeon group than in the nonpediatric orthopedic surgeon group. There were no other significant differences in outcomes between the fractures treated by the pediatric orthopedic surgeons and nonpediatric orthopedic surgeons. Conclusions This study supports the assertion that both pediatric and nonpediatric orthopedic surgeons in an academic setting have sufficient training, skill, and experience to treat these common injuries.

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Early versus delayed treatment of extension type-3 supracondylar fractures of the humerus in children

Cited by 85 publications

References 6 publications

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

An evaluation of supracondylar humerus fractures: Is there a correlation between postponing treatment and the need for open surgical intervention?

Pediatric supracondylar humerus fractures: Treatment by type of orthopedic surgeon

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